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In the pivotal randomized controlled trials (RCTs) for patients with atrial fibrillation, direct oral anticoagulants (DOACs) had similar or even superior efficacy and safety compared to warfarin. However, RCTs comparing different DOACs are non-existent and previous observational studies have yielded conflicting results. In this nationwide cohort study, rates of any stroke or systemic embolism (stroke/SE) and major bleeding were compared between new users of apixaban, dabigatran, and rivaroxaban with atrial fibrillation from 2014-2019. Inverse probability weighting was used to yield balanced study groups and outcomes were compared using Cox regression. Stroke/SE rates were similar between patients receiving apixaban, dabigatran, and rivaroxaban. Dabigatran was associated with twofold higher rates of myocardial infarction compared to rivaroxaban (1.4 events/100-py vs 0.7 events/100-py, HR 2.21, 95% CI 1.00-4.90) and apixaban (1.4 events/100-py vs 0.7 events/100-py, HR 2.26, 95% CI 0.90-5.67), although the second comparison included the possibility of a null effect. Rivaroxaban was associated with higher major bleeding rates compared to apixaban (2.9 events/100-py vs 1.8 events/100-py, HR 1.64, 95% CI 1.13-2.37) and dabigatran (2.9 events/100-py vs 1.4 events/100-py, HR 2.18, 95% CI 1.21-3.93). Specifically, rivaroxaban had higher rates of major gastrointestinal bleeding and other major bleeding compared to apixaban. In conclusion, while stroke/SE rates were similar between DOACs, rivaroxaban was associated with higher rates of major bleeding compared to other DOACs and lower rates of myocardial infarction compared to dabigatran. These results may help guide oral anticoagulant selection, especially in patients at high risk of bleeding or myocardial infarction.

To estimate the frequency of iron deficiency (ID) and anaemia in blood donors in Iceland and the impact of serum ferritin (SF) testing policy change.Blood donations contribute to ID and/or anaemia in whole blood donors (WBD). SF may be used to monitor blood donor iron stores.The study included WBD and new donors (ND) in the Icelandic Blood Bank in 1997-2019. SF was measured for ND and intermittently for WBD until October 2017, but thereafter for all WBD and ND at every visit. In January 2018, the SF threshold increased from 14 to 16 μg/L for ND and from 8 to 10 μg/L for WBD.The study included 85 370 SF results from 243 369 visits of 32 910 donors. Median SF was higher for males than females, both for ND (88.0 vs. 31.2 μg/L, p 0.001) and WBD (before 2018: 43.0 vs. 22.0 μg/L, p 0.001). After the policy change in 2018, median SF increased for both male WBD (to 45.2 μg/L, p 0.001) and female WBD (to 25.7 μg/L, p 0.001). ID (SF15 μg/L) was present in 10.6% of female ND and 0.5% of male ND. After policy change, the proportion of WB donations associated with ID decreased for males (from 6.4% to 4.0%) and females (from 18.9% to 14.1%). ID anaemia was present at some time in 3.7% of female WBD and 1.2% of male WBD.This nationwide study showed that ID in WB donors is common, especially among females, but monitoring SF may improve donor management.

Introduction The aim of this study was to explore the attitudes of Icelandic women towards existing genetic information, genetic counseling and genetic testing for BRCA mutations which dramatically increase risk for aggressive cancers. Materials and methods Women attending the cancer prevention clinic in Reykjavik, capital of Iceland, from October 12th until November 20th 2015 received an invitation to participate. Participation involved answering a short online questionnaire about background, family history of cancer as well as attitudes towards genetic counseling, BRCA testing and preventive use of such information. Descriptive statistics and chi-square tests were used to describe differences in attitudes towards those questions between subgroups of women. Results 1129 women (69% response rate) answered the questionnaire. Mean age was 47 years (span 21-76 years). Around half (47%) had heard fairly much about the mutations. Independent of family history of cancer, the majority of women were positive towards receiving genetic counseling (79%) and to undergo genetic testing (83%) for BRCA mutation with younger women being more interested than older women. On the other hand, only 4% of the women had already received genetic counseling and 7% undergone genetic testing. Women with family history of cancer were more knowledgeable about BRCA mutations (p0.0001) and were less afraid of the consequence of being a mutation carrier (p0.0001) compared to those with little or no family history. Regardless of family history, half (49%) worried that results from genetic testing could influence their health insurance. Almost all, or 97% of the women, were positive or very positive toward using existing genetic information obtained through scientific work, to inform affected indi-viduals of their mutation status. Conclusion Icelandic women are positive towards genetic counseling and testing for BRCA mutations although half of them worry that a positive result might affect their health insurance. Nevertheless, almost all women believe that existing genetic information should be used to inform carriers for preventive purposes.

The aim of this study is to describe the characteristics of patients who underwent a fast diagnostic track (FDT) due to suspected lung cancer at Landspitali University Hospital, Iceland.Hospital records were reviewed on background characteristics, diagnosis, staging, waiting times and survival of all 550 patients (mean age 68.1 years, 57% female) that participated in the FDT from February 1, 2008 to January 31, 2015. Adjusting for clinical characteristics in a multivariate analysis, overall survival was compared for patients diagnosed with lung cancer within or outside the FDT in Iceland in 2014 (n=167, mean age 69.3 years, 61.7% female).Of the 550 FDT patients, 426 were diagnosed with lung cancer (77.5%); 346 of the non-small cell type (NSCLC) (81.2%). The proportion of patients receiving lung cancer diagnosis through the FDT increased from 23.3% in 2008 to 47.9% in 2014 (p0.001). The waiting time from referral to diagnosis was 10 days median and 19 days from diagnosis to initiation of treatment. More patients with advanced disease were diagnosed outside the FDT (70.1% vs. 37.5%, p0.05). When ad-- justed for age, sex, histology, stage at diagnosis and therapy, patients diagnosed with lung cancer outside the FDT had higher risk of all-cause mortality (HR 1.60; 95% CI: 0.95 - 2.71) although the difference was not statistically significant.An increasing proportion of lung cancer diagnosis in Iceland is made through a fast diagnostic track with potential benefits for patients. The waiting time from referral to diagnosis and treatment is in line with international guidelines. Key words: lung cancer, non-small cell lung cancer, diagnostic track, waiting times, survival. Correspondence: Hronn Hardardottir, hronnh@landspitali.is.

In the mid twentieth century gastric cancer was the most common type of cancer in Iceland. In recent decades, however, the incidence rate of gastric cancer has decreased markedly and currently only represents 2-3% of cancer cases. The Laurén classification system classifies adenocarcinoma into two types, intestinal and diffuse. The main purpose of our study was to describe the epidemiology of the two types of gastric adenocarcinoma in Iceland between the years 1990-2009.This is a retrospective cohort study. Information on patients diagnosed with gastric cancer in Iceland between 1990 and 2009 was collected from the population based Cancer Registry. Histological descriptions were reviewed and classified according to the Laurén classification system. The records of patients diagnosed with either having intestinal or diffuse adenocarcinomas were reviewed and epidemiological information gathered.Between 1990 and 2009, 730 patients were diagnosed with gastric adenocarcinoma in Iceland, 447 had intestinal adenocarcinoma and 168 diffuse adenocarcinoma. Patients diagnosed with diffuse adenocarcinoma were significantly younger at diagnosis than those diagnosed with intestinal adenocarcinoma. The sex ratio for intestinal adenocarcinoma was 2.3:1 (M:F) and 1.1:1 (M:F) for diffuse adenocarcinoma. The incidence of intestinal adenocarcinoma decreased more rapidly than that of diffuse adenocarcinoma during this period (0.92/100,000 vs. 0.12/100,000). Median survival rates of intestinal and diffuse adenocarcinomas were 23.7 and 20.6 months, respectively. The difference in survival was found to be statistically significant. The hazard ratio between the two groups was 1.31 (CI 1.03-1.67), corrected for age, sex, stage, year of diagnosis and surgical outcome (radical, non-radical or no operation).The overall incidence rate of gastric cancer has decreased dramatically in the past 20 years. However, the reduction is largely limited to the intestinal adenocarcinoma sub-group. We conclude that the Laurén classification predicts prognosis in gastric adenocarcinoma with diffuse adenocarcinoma having worse prognosis.gastric cancer, Laurén classification, survival, incidence. Correspondence: Halla Sif Olafsdottir, hsolafsdottir@gmail.com.